Association of Adenoma and Proximal Sessile Serrated Polyp Detection Rates With Endoscopist Characteristics.

Authors:
Shashank Sarvepalli
Shashank Sarvepalli
Cleveland Clinic
Ari Garber
Ari Garber
University of Vermont College of Medicine
United States
Michael B Rothberg
Michael B Rothberg
Medicine Institute
United States
Gautam Mankaney
Gautam Mankaney
The Cleveland Clinic
John McMichael
John McMichael
Mayo Clinic
United States
Gareth Morris-Stiff
Gareth Morris-Stiff
Royal Glamorgan Hospital
United Kingdom
John J Vargo
John J Vargo
Digestive Disease Institute
Seattle | United States
Maged K Rizk
Maged K Rizk
Digestive Disease Institute
United States

JAMA Surg 2019 Apr 17. Epub 2019 Apr 17.

Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.

Importance: Research demonstrates adenoma detection rate (ADR) and proximal sessile serrated polyp detection rate (pSSPDR) are associated with endoscopist characteristics including sex, specialty, and years in practice. However, many studies have not adjusted for other risk factors associated with colonic neoplasia.

Objective: To assess the association between endoscopist characteristics and polyp detection after adjusting the factors included in previous studies as well as other factors.

Design, Setting, And Participants: This cohort study was conducted in the Cleveland Clinic health system with data from individuals undergoing screening colonoscopies between January 2015 and June 2017. The study analyzed data using methods from previous studies that have demonstrated significant associations between endoscopist characteristics and ADR or pSSPDR. Multilevel mixed-effects logistic regression was performed to examine 7 endoscopist characteristics associated with ADRs and pSSPDRs after controlling for patient demographic, clinical, and colonoscopy-associated factors.

Exposures: Seven characteristics of endoscopists performing colonoscopy.

Main Outcomes And Measures: The ADR and pSSPDR, with a hypothesis created after data collection began.

Results: A total of 16 089 colonoscopies were performed in 16 089 patients by 56 clinicians. Of these, 8339 patients were male (51.8%), and the median (range) age of the cohort was 59 (52-66) years. Analyzing the data by the methods used in 4 previous studies yielded an association between endoscopist and polyp detection; surgeons (OR, 0.49 [95% CI, 0.28-0.83]) and nongastroenterologists (OR, 0.50 [95% CI 0.29-0.85]) had reduced odds of pSSPDR, which was similar to results in previous studies. In a multilevel mixed-effects logistic regression analysis, ADR was not significantly associated with any endoscopist characteristic, and pSSPDR was only associated with years in practice (odds ratio, 0.86 [95% CI, 0.83-0.89] per increment of 10 years; P < .001) and number of annual colonoscopies performed (odds ratio, 1.05 [95% CI, 1.01-1.09] per 50 colonoscopies/year; P = .02).

Conclusions And Relevance: The differences in ADRs that were associated with 7 of 7 endoscopist characteristics and differences in pSSPDRs that were associated with 5 of 7 endoscopist characteristics in previous studies may have been associated with residual confounding, because they were not replicated in this analysis. Therefore, these characteristics should not influence the choice of endoscopist for colorectal cancer screening. However, clinicians further from their training and those with lower colonoscopy volumes have lower adjusted pSSPDRs and may need additional training to help increase pSSPDRs.

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Source
http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/jam
Publisher Site
http://dx.doi.org/10.1001/jamasurg.2019.0564DOI Listing
April 2019
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